What is a Neuroma?
A neuroma is a swollen growth of nerve tissue, typically in bottom of the foot between the third and fourth toes. It’s often referred to as a pinched nerve or a nerve tumor. This growth is benign, but is painful and can lead to permanent nerve damage. Neuroma pain is often described as burning and tingling, sometimes accompanied by numbness in one or two toes. Additionally, you may feel a pop in your step while walking. Sometimes the pain will go away if the area is not aggravated for a while, but it can easily return.
When the neuroma is in between the third and fourth toes of your foot — the most common spot — it’s called a Morton’s Neuroma. Neuromas can still occur in other spots on your foot, however, including your heel.
Causes of Neuromas
Neuromas as most commonly caused by abnormal movement in the metatarsal bones — these are the long bones behind your toes. A small nerve passes through these bones and splits into your toes. Abnormal bone movement can pinch the nerve, causing it to swell and form a neuroma.
Furthermore, a neuroma may be caused by a cut or a puncture wound near the nerve of a foot. Sometimes, a foot surgery near the nerve can result in the development of a neuroma.
If the pain and swelling in the bottom of your foot indicates a neuroma, your podiatrist will perform an examination to make sure these aren’t symptoms of a stress fracture, inflammation of tendons in your toes, nerve compression, or nerve damage in another area of your body reflecting into your foot.
An x-ray is generally a reliable method of ruling out a stress fracture or arthritis since a neuroma won’t show up in an x-ray. A skilled podiatrist should be able to feel a neuroma on the foot without much more assistance than the x-ray results. If your doctor feels no swelling, then they will continue to evaluate other areas of the foot or ankle where a nerve compression may be occurring.
Tarsal Tunnel Syndrome in the ankle is known to cause pain in the bottom of the foot or toes as well, and can often be confused with a neuroma, but it is less common than a neuroma. A skilled podiatrist will be able to determine the difference.
Treatment for Neuromas
A cortisone treatment is the most common and preferred method of treatment for a neuroma. Cortisone shrinks the swelling of the nerve, relieving the pressure on the nerve. While a cortisone injection will relieve the pain, it doesn’t cure the neuroma on its own because the metatarsal bones can still aggravate the area.
Custom-molded orthotic inserts for your shoes should correct abnormal movement of the metatarsal bones. Combined with cortisone injections, this treatment should eliminate your neuroma.
Less commonly, if the damage to the nerve is significant, the patient may require a chemical destruction of the nerve, surgical removal of the nerve, or decompression of the nerve.